Healthcare Provider Details

I. General information

NPI: 1558052076
Provider Name (Legal Business Name): LAUREL ELIZABETH SMITH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4912 HIGBEE AVE NW STE 200
CANTON OH
44718-2599
US

IV. Provider business mailing address

1280 CONCORD ST NW
MASSILLON OH
44646-2269
US

V. Phone/Fax

Practice location:
  • Phone: 330-492-2844
  • Fax:
Mailing address:
  • Phone: 330-685-3263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA.02438
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: